Commentary: remaining questions on moderate alcohol drinking and cancer risk

In January 2025, the United States Surgeon General issued an advisory describing the scientific evidence for the causal link between alcohol consumption and increased cancer risk. The report is timely as the link between alcohol and cancer is well established. Few would dispute the generally adverse effects of alcohol consumption on cancer risk and overall health with excessive levels of intake. More controversy exists at light-to-moderate levels of intake, such as not exceeding 2 drinks per day for men or 1 drink per day for women. Cancer risk may be the biggest concern in the low-moderate range of drinking as about one-quarter of cancer cases attributable to alcohol consumption arise in those consuming two or fewer alcoholic drinks daily. In moderate alcohol consumers, four modifying factors merit consideration, tobacco use, drinking frequency, whether drinking is with meals or on an empty stomach, and beverage type. Conclusions based simply on the overall dose-response without considering these factors is inadequate. A more thorough synthesis of the current literature and new studies and analyses designed to address these questions is imperative for developing practical recommendations for low-to-moderate alcohol drinking.